BACKGROUND: Cerebral palsy (CP) is the most common cause of physical disability in childhood defined as a group of permanent disorders of movement. The aim of this study was to determine the effects of 12-week aquatic exercise program on gross motor function, swimming skills, and walking ability in children with cerebral palsy. METHODS: Eighteen children (mean±SD age: 12.3±3 years) with cerebral palsy classified at levels I, II and III on the Gross Motor Function Classification System were allocated to one group, where the first 12 weeks were a control period while another 12 weeks were an experimental period. The participants underwent the same battery of tests focusing gross motor function, swimming skills, and walking ability on three occasions. RESULTS: Control period was stable with no significant changes in any of measurements. After the 12-week experimental program, a statistically significant improvement was determined in gross motor function (P=0.005), swimming skills (P=0.000), walking endurance and walking velocity (P=0.000). No significant differences (P>0.05) were observed for walking efficiency. CONCLUSIONS: The 12-week aquatic exercise program (3/week, 60 minutes), combining Halliwick method, swimming and walking activities may improve the gross motor function, swimming skills, walking endurance and velocity in ambulatory children with cerebral palsy.
Aim: The study aims to determine the level of family burden and psychological symptoms in mothers who have children with Cerebral Palsy (CP) in Turkey. Methods: The descriptive study was completed with 200 mothers of children with CP. Results: Depression was found in mothers (1.11 ± 0.79) and the Family Burden Assessment Scale (FBAS) mean score was also high (143.71 ± 22.68). A statistically significant difference was found between mothers who received support to care for their children and their level of depression (p = 0.003). A positive and significant relationship was also found between emotional burden and psychiatric symptoms, such as anxiety, depression, negative self-perception, somatization, and hostility (r = 0.458, p = 0.001; r = 0.552, p = 0.001; r = 0.494, p = 0.001; r = 0.376, p = 0.001; r = 0.404, p = 0.001), respectively. A weak and positive relationship was determined between time requirement and psychiatric symptoms, such as anxiety, depression, and negative self-perception (r = 0.166, p = 0.019; r = 0.259, p = 0.001; r = 0.223, p = 0.001, respectively). Conclusion: The main factor affecting depression in caregivers was lack of support. As the mothers' emotional burden increases, their psychiatric symptom scores also increase. In our study, mothers' anxiety, depression, and negative self-perception scores increase as their time requirements increase. Mothers should be supported with certain interventions, such as education and instruction, to meet the necessities while caring for their children. Policymakers should support mothers with low-income levels to ensure that the required services reach their recipients. Psychological support and counseling services can be provided to the children and mothers following the diagnosis of CP.
Autoři předkládají první zkušenosti s novým ošetřovacím dnem následné komplexní intenzivní léčebně rehabilitační péče dětských pacientů s diagnózou dětské mozkové obrny, která má přidělený kód Ministerstvem zdravotnictví 0035. Tato péče je tedy hrazena z prostředků veřejného zdravotního pojištění. Efekt terapie je hodnocen standardizovaným GMFM-88 (gross motor function measure) testem. V souboru bylo hodnoceno celkem 32 dětí s průměrným věkem 8,4 let. Převažovaly děti s III. stupněm psychomotorického postižení dle GMFCS (gross motor function classification system). Efekt terapie probíhající 2× ročně s délkou rehabilitačního pobytu vždy 1 měsíc je statisticky významný nejen v celkovém skóre, ale také v jednotlivých položkách GMFM testu. Zlepšení se týká pohybových dovedností ve všech posturálních polohách. Děti profitují nejen v rovině pohybové, ale i na úrovni rozvoje kognitivních funkcí a v celkovém vývojovém trendu.
The authors present the first experience with the new treatment method – comprehensive intensive medical rehabilitation for children with cerebral palsy which the Ministry of Health designates with the code 00035.This care is therefore covered by public health insurance funds. The effect of the therapy is assessed by the standardized GMFM-88 (gross motor function measure) test. A total of 32 children with an average age of 8.4 years were evaluated in the group. Children with degree III of psychomotor disability according to the GMFCS (gross motor function classification system) predominated. The effect of therapy taking place twice a year with a rehabilitation stay of 1 month is statistically significant, not only in the total score, but also in the individual items of the GMFM test. The improvement therefore concerns movement skills in all postural positions. Children benefit not only on the level of movement, but also on the level of development of cognitive functions and in the overall development trend.
- Klíčová slova
- sanatorium Klimkovice,
- MeSH
- dítě MeSH
- hodnocení výsledků pacienta MeSH
- lidé MeSH
- mladiství MeSH
- mozková obrna * rehabilitace MeSH
- neurorehabilitace metody MeSH
- výsledek terapie MeSH
- zdravotnická zařízení MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
PURPOSE: This pooled analysis of data from three Phase 3 studies investigated the effects of incobotulinumtoxinA on spasticity-related pain (SRP) in children/adolescents with uni-/bilateral cerebral palsy (CP). METHODS: Children/adolescents (ambulant and non-ambulant) were evaluated for SRP on increasingly difficult activities/tasks 4 weeks after each of four incobotulinumtoxinA injection cycles (ICs) using the Questionnaire on Pain caused by Spasticity (QPS; six modules specific to lower limb [LL] or upper limb [UL] spasticity and respondent type [child/adolescent, interviewer, or parent/caregiver]). IncobotulinumtoxinA doses were personalized, with all doses pooled for analysis. RESULTS: QPS key item responses were available from 331 and 155 children/adolescents with LL- and UL-spasticity, respectively, and 841/444 (LL/UL) of their parents/caregivers. IncobotulinumtoxinA efficacy was evident with the first IC. Efficacy was sustained and became more robust with further subsequent ICs. By Week 4 of the last (i.e. fourth) IC, 33.8-53.3% of children/adolescents reported complete SRP relief from their baseline pain for respective QPS items. Children/adolescents reported reductions in mean LL SRP intensity at levels that surpassed clinically meaningful thresholds. Similarly, parents/caregivers observed complete SRP relief and less frequent SRP with incobotulinumtoxinA. Similar results were found for UL SRP. CONCLUSION: These findings indicate that incobotulinumtoxinA could bring considerable benefit to children/adolescents with spasticity by reducing SRP, even during strenuous activities.
- MeSH
- bolest farmakoterapie etiologie MeSH
- botulotoxiny typ A * terapeutické užití MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mozková obrna * komplikace farmakoterapie MeSH
- nervosvalové látky * terapeutické užití MeSH
- svalová spasticita farmakoterapie etiologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
- MeSH
- konzervativní terapie MeSH
- lidé MeSH
- mozková obrna diagnóza etiologie rehabilitace terapie MeSH
- neuromuskulární nemoci * diagnóza etiologie komplikace terapie MeSH
- ortopedické výkony metody MeSH
- poliomyelitida diagnóza komplikace prevence a kontrola terapie MeSH
- poporodní paréza brachiálního plexu diagnóza etiologie terapie MeSH
- úžinové syndromy diagnóza etiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- asfyxie novorozenců diagnóza terapie MeSH
- edém mozku etiologie farmakoterapie MeSH
- lidé MeSH
- mozková obrna * diagnóza MeSH
- novorozenec MeSH
- porod doma * škodlivé účinky MeSH
- těhotenství mnohočetné fyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Spasticita je závažným klinickým projevem poškození centrálního motoneuronu, k němuž dochází při ischemii, hemoragii, traumatu, zánětu, nádoru či v rámci neurodegenerativních onemocnění. Rozlišují se dva typy spasticity - cerebrální a spinální. U cerebrálních lézí dochází ke ztrátě vlivu mozkové kůry na kmenové inhibiční struktury, zatímco u spinálních lézí je přítomna spastická dystonie a převažuje postižení flexorů. Pro posouzení typu a stupně spasticity je důležité u každého nemocného provést pečlivé klinické vyšetření. K tomu slouží řada škál a dotazníkových metod. Nejčastěji se používá Ashworthova stupnice svalového hypertonu a její modifikace. Cílem léčby spasticity je zlepšit funkci spastických končetin, zvýšit soběstačnost pacienta, snížit výskyt komplikací, zmírnit doprovodné bolesti, zlepšit kvalitu života. Léčba spasticity zahrnuje rehabilitaci a farmakologickou léčbu, případně ji lze řešit chirurgicky. Jednotlivé léčebné postupy je možno zvolit podle stupně a intenzity spasticity, ale záleží i na aktivitách a cílech konkrétního nemocného. Obvykle se začíná kombinací rehabilitace a farmakologické léčby. Z léčiv se nejčastěji používá baklofen a tizanidin, případně kanabinoidy. Lokalizovanou spasticitu lze ovlivnit aplikací botulotoxinu do spastických svalových skupin. U těžké difuzní spasticity má velmi dobrý efekt intratékální podání baklofenu pumpovými systémy. V indikovaných případech lze přistoupit k chirurgickému řešení (myelotomie, DREZotomie). Léčba spasticity je dlouhodobá a vyžaduje multidisciplinární přístup.
Spasticity is one of the serious clinical manifestations of damage to the central motoneuron, which occurs during ischemia, hemorrhage, trauma, inflammation, tumor or as part of neurodegenerative disorders. There are two types of spasticity - cerebral and spinal. In cerebral lesions, there is a loss of the influence of the cerebral cortex on trunk inhibitory structures, while in spinal lesions, spastic dystonia of a severe degree is present and flexor involvement predominates. A careful clinical examination of each patient is important to assess the type and degree of spasticity. A number of scales and questionnaire methods are used for this. Ashworth scale of muscle hypertonia and its modifications are most often used. The goal of spasticity treatment is to improve the function of spastic limbs, enable better independence, reduction of complications, decrease of accompanying pain, and improvement quality of life. The treatment of spasticity consists of rehabilitation, pharmacological or can be solved surgically. Individual treatment procedures are chosen according to the degree and intensity of spasticity, but it also depends on the activities and goals of the specific patient. Treatment of spasticity in most cases begins with a combination of rehabilitation and pharmacological treatment. The most often used drugs are baclofen and tizanidine, or cannabinoids. Focal spasticity can be treated by administration of botulinum toxin into spastic muscle groups. In severe diffuse spasticity, the intrathecal administration of baclofen by continuous pump systems has a very good effect. In some cases, a surgical approach to spasticity treatment (myelotomy, DREZotomy) can also be chosen. The treatment of spasticity is a long-term process and requires multidisciplinary approach.
- MeSH
- antikonvulziva aplikace a dávkování terapeutické užití MeSH
- baklofen aplikace a dávkování farmakologie terapeutické užití MeSH
- botulotoxiny aplikace a dávkování terapeutické užití MeSH
- centrálně působící myorelaxancia MeSH
- lidé MeSH
- mozková obrna * diagnóza rehabilitace terapie MeSH
- svalová spasticita * diagnóza rehabilitace terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.
- MeSH
- acetabulum MeSH
- dítě MeSH
- kyčelní kloub chirurgie MeSH
- lidé MeSH
- luxace kyčle * diagnostické zobrazování etiologie chirurgie MeSH
- mladiství MeSH
- mozková obrna * komplikace chirurgie MeSH
- následné studie MeSH
- pánev MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
Vertical jump (VJ) capacity is a common assessment for monitoring athletes' neuromuscular function and has been proposed as a differentiating indicator between competitive levels of football players. This study aimed to compare the VJ capacity of Chilean footballers with cerebral palsy (CP) with international and national levels of proficiency, also according to their sport classes (i.e., FT1‒FT3). A total sample of 41 male footballers with CP were divided into international-level (n = 18) and national-level (n = 23) groups. All the participants performed two maximal squat jumps (SJs) and countermovement jumps (CMJs), where the best height obtained was registered. The VJ performance was significantly different between competitive levels, and players at international level had better scores (p < .001) than the national level in SJ (dg = 1.83, large) and CMJ (dg = 2.08, large). Considering the sport classes, significant differences were found in SJ (p = .024) and CMJ (p = .035), in which FT3 players performed higher jumping heights than FT1 players (dg = -.84 to -1.01, large). These results provide a deeper understanding of the differences in the motor impairment-specific performance of para-footballers with CP, where coaches and strength-conditioning professionals should consider VJ assessment for monitoring training and as a component for talent detection in this para-sport.
- MeSH
- fotbal MeSH
- lidé MeSH
- mozková obrna MeSH
- para sportovci MeSH
- sportovní výkon MeSH
- sporty pro handicapované * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
- Geografické názvy
- Chile MeSH
INTRODUCTION: Cerebral palsy (CP) is a group of permanent disorders attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Cerebral palsy-like (CP-like) disorders may clinically resemble CP but do not fulfill CP criteria and have often a progressive course and/or neurodevelopmental regression. To assess which patients with dystonic CP and dystonic CP-like disorder should undergo Whole Exome Sequencing (WES), we compared the rate of likely causative variants in individuals regarding their clinical picture, co-morbidities, and environmental risk factors. METHOD: Individuals with early onset neurodevelopmental disorder (ND) manifesting with dystonia as a core feature were divided into CP or CP-like cohorts based on their clinical picture and disease course. Detailed clinical picture, co-morbidities, and environmental risk factors including prematurity, asphyxia, SIRS, IRDS, and cerebral bleeding were evaluated. RESULTS: A total of 122 patients were included and divided into the CP group with 70 subjects (30 males; mean age 18y5m±16y6m, mean GMFCS score 3.3 ± 1.4), and the CP-like group with 52 subjects (29 males; mean age 17y7m±1y,6 m, mean GMFCS score 2,6 ± 1,5). The WES-based diagnosis was present in 19 (27.1%) CP patients and 30 CP-like patients (57.7%) with genetic conditions overlap in both groups. We found significant differences in diagnostic rate in CP individuals with vs. without risk factors (13.9% vs. 43.3%); Fisher's exact p = 0.0065. We did not observe the same tendency in CP-like (45.5% vs 58.5%); Fisher's exact p = 0.5. CONCLUSION: WES is a useful diagnostic method for patients with dystonic ND, regardless of their presentation as a CP or CP-like phenotype.
- MeSH
- dystonické poruchy * genetika komplikace MeSH
- dystonie * genetika komplikace MeSH
- lidé MeSH
- mozek MeSH
- mozková obrna * genetika MeSH
- sekvenování exomu MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
